Classification System of Vaginal Prostheses and Graft Complications Recommended by the International Urogynecological Association (IUGA) and International Continence Society (ICS)




An International Urogynecological Association (IUGA)/International Continence Society (ICS) Joint Terminology and Classification of the Complications Related Directly to the Insertion of Prostheses (meshes, implants, tapes) & Grafts in Female Pelvic Floor Surgery.


Haylen BT, Freeman RM, Swift SE, Cosson M, Davila GW, Deprest J, Dwyer PL, Fatton B, Kocjancic E, Lee J, Maher C, Petri E, Rizk DE, Sand PK, Schaer GN, Webb RJ. Int Urogynecol J . 2011;22:3.



Table D.1

Terminology Involved in the Classification





























































Terminology Used Definition
Prosthesis A fabricated substitute to assist a damaged body part or to augment or stabilize a hypoplastic structure
Mesh A (prosthetic) network fabric or structure
Implant A surgically inserted or embedded prosthesis
Tape (sling) A flat strip of synthetic material
Graft Any tissue or organ for transplantation; referring to biological materials inserted
Autologous graft From the woman’s own tissues (e.g., dura mater, rectus sheath or fascia lata)
Allograft From postmortem tissue banks
Xenograft From other species (e.g., modified porcine dermis, porcine small intestine, bovine pericardium)
Complication A morbid process or event that occurs during the course of a surgery that is not an essential part of that surgery
Contraction Shrinkage or reduction in size
Prominence Parts that protrude beyond the surface (e.g., from wrinkling or folding with no epithelial separation)
Separation Physically disconnected (e.g., vaginal epithelium)
Exposure A condition of displaying, revealing, exhibiting, or making accessible (e.g., vaginal mesh visualized through the separated vaginal epithelium)
Extrusion Passage gradually out of a body structure or tissue
Compromise Bring into danger
Perforation Abnormal opening into a hollow organ or viscus
Dehiscence A bursting open or gaping along natural or sutured line
Sinus Tract Formation (Localized) formation of a fistulous tract toward vagina or skin, where there is no visible implant material in the vaginal lumen or overlying skin.


Box D.1

Categories for Classification System









  • 1.

    Vaginal complication – No epithelial separation



    • A.

      Asymptomatic



      • a.

        No pain



    • B.

      Symptomatic



      • a.

        No pain


      • b.

        Provoked pain only (e.g., during vaginal examination)


      • c.

        Pain during sexual intercourse


      • d.

        Pain during physical activities


      • e.

        Spontaneous pain



    • C.

      Clinical infection



      • a.

        No pain


      • b.

        Provoked pain only (e.g., during vaginal examination)


      • c.

        Pain during sexual intercourse


      • d.

        Pain during physical activities


      • e.

        Spontaneous pain



    • D.

      Abscess formation



      • a.

        No pain


      • b.

        Provoked pain only (e.g., during vaginal examination)


      • c.

        Pain during sexual intercourse


      • d.

        Pain during physical activities


      • e.

        Spontaneous pain




  • 2.

    Vaginal complication – Smaller exposure, 1 cm or less



    • A.

      Asymptomatic



      • a.

        No pain



    • B.

      Symptomatic



      • a.

        No pain


      • b.

        Provoked pain only (e.g., during vaginal examination)


      • c.

        Pain during sexual intercourse


      • d.

        Pain during physical activities


      • e.

        Spontaneous pain



    • C.

      Clinical infection



      • a.

        No pain


      • b.

        Provoked pain only (e.g., during vaginal examination)


      • c.

        Pain during sexual intercourse


      • d.

        Pain during physical activities


      • e.

        Spontaneous pain



    • D.

      Abscess formation



      • a.

        No pain


      • b.

        Provoked pain only (e.g., during vaginal examination)


      • c.

        Pain during sexual intercourse


      • d.

        Pain during physical activities


      • e.

        Spontaneous pain





  • 3.

    Vaginal complication – Larger exposure or extrusion, more than 1 cm



    • A.

      Asymptomatic



      • a.

        No pain



    • B.

      Symptomatic



      • a.

        No pain


      • b.

        Provoked pain only (e.g., during vaginal examination)


      • c.

        Pain during sexual intercourse


      • d.

        Pain during physical activities


      • e.

        Spontaneous pain



    • C.

      Clinical infection



      • a.

        No pain


      • b.

        Provoked pain only (e.g., during vaginal examination)


      • c.

        Pain during sexual intercourse


      • d.

        Pain during physical activities


      • e.

        Spontaneous pain



    • D.

      Abscess formation



      • a.

        No pain


      • b.

        Provoked pain only (e.g., during vaginal examination)


      • c.

        Pain during sexual intercourse


      • d.

        Pain during physical activities


      • e.

        Spontaneous pain




  • 4.

    Urinary tract compromise or perforation



    • A.

      Small intraoperative defect


    • B.

      Other lower urinary tract (bladder or urethral) complication or compromise



  • 5.

    Rectal or bowel compromise or perforation



    • A.

      Small intraoperative defect


    • B.

      Rectal injury or compromise


    • C.

      Small or large bowel injury or compromise


    • D.

      Abscess formation from bowel injury/compromise



  • 6.

    Skin or musculoskeletal complication



    • A.

      Asymptomatic


    • B.

      Symptomatic


    • C.

      Infection from skin or musculoskeletal complication


    • D.

      Abscess formation from skin or musculoskeletal complication



  • 7.

    Patient compromise—including hematoma or systemic compromise



    • A.

      Bleeding complication including hematoma


    • B.

      Major degree of resuscitation or intensive care


    • C.

      Mortality


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May 16, 2019 | Posted by in GYNECOLOGY | Comments Off on Classification System of Vaginal Prostheses and Graft Complications Recommended by the International Urogynecological Association (IUGA) and International Continence Society (ICS)

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